Once known as a disease only suffered by the wealthy, gout now affects more than five million Americans, and more cases are being diagnosed every day. Anyone who has ever experienced the pain of gout will do anything they can to avoid another attack. In this guide, you will discover what gout is, the causes of it, typical symptoms, and what treatments are available.
A Brief Overview of Gout
Gout is a certain form of arthritis. It is caused by too much uric acid in the blood. Most of the time, having too much uric acid isn’t harmful. Many people with high levels in their blood never get gout. But when uric acid levels in your blood are too high, the uric acid may form hard crystals in your joints. These crystals can cause a range of symptoms all over the body, though the most common joint affected is the big toe.
Symptoms of Gout
The first gout attack is one that most patients remember with horrifying clarity. It usually affects the big toe, causing sudden burning pain, stiffness, and swelling. It is so painful that even a bed sheet touching the toe is agony. Many people are awakened in the middle of the night by the attack.
Gout usually affects the large joint of your big toe, but it can occur in your feet, ankles, knees, hands, wrists and elbows as well. The pain is likely to be most severe within the first 4 to 12 hours after the attack begins.
Even after the pain finally goes away, the joint will feel stiff and tender for several days to several weeks afterwards. Later attacks will often be as severe, likely to last longer, and affect more than just one joint. Some people might have fewer attacks, but the ones they do have will be excruciatingly painful.
Each joint attacked will become red and inflamed. The joints will become swollen, tender, red, and might feel warm to the touch. The swelling and inflammation can trigger stiffness and a lack of mobility. Over time this will get worse, limiting motion and range of motion, leading to further stiffness and pain.
Gout is not just a health issue because it’s so painful. These attacks will happen again and again as long as the gout isn’t treated. These repeated attacks will lead to permanent damage to the joints, tendons, and other connective tissues.
Who Gets Gout?
Gout is an arthritic condition that is most common in men, as compared with, say, rheumatoid arthritis. Rheumatoid arthritis is an autoimmune form of arthritis in which the body starts to attack itself. More than 80% of sufferers are women.
With gout on the other hand, according to the Centers for Disease Control and Prevention, men are three times more likely to suffer from gout than women, and black men are twice as likely to suffer gout compared with white men. No one is really sure why there are gender differences in relation to various forms of arthritis, but being a man aged from 30 to 50 who is African-American are known risk factors for gout.
Causes of Gout
Gout has been on the rise in the past decade as a serious health concern. The most likely risk factors for developing gout include:
- Being overweight
- Drinking too much alcohol, especially beer or wine
- Eating too much red meat, such as beef and lamb
- Eating too many organ meats such as heart and kidneys
- Eating too much of certain kinds of fish and shellfish
- Eating too many foods that are high in chemicals called purines
- Drinking too many beverages sweetened with fructose (a certain kind of sugar)
Some medicines, such as diuretics (used to remove excess water from the body) can also bring on gout. So too can aspirin, even low-dose aspirin that many people take to prevent a heart attack. Anti-rejection drugs after an organ transplant are also a known cause of gout.
Other Risk Factors for Gout
Medical Conditions
Certain diseases and medical conditions make it more likely that you’ll develop gout. These include:
- Untreated high blood pressure
- Diabetes, metabolic syndrome
- Heart disease
- Kidney disease
- Family history of gout – If other members of your family have had gout, you’re more likely to develop the disease as well.
- Age and gender – Gout occurs more often in men because women tend to have lower uric acid levels. However, it is important to note that once a woman reaches menopause, a woman’s uric acid levels will approach those of men. Men also are more likely to develop gout earlier, often between the ages of 30 and 50. Women develop signs and symptoms after menopause, that is, their late 40s to early 50s.
- Recent surgery or injury – Experiencing recent surgery or injury to a joint has been associated with an increased risk of developing gout.
Why Does Gout Occur?
Normally, uric acid dissolves in your blood and passes through your kidneys into your urine, to be eliminated from the body. But sometimes your body either produces too much uric acid, or your kidneys excrete too little uric acid.
In both cases, uric acid can build up, forming sharp, needle-like urate crystals in a joint or in its surrounding tissue. This causes pain, inflammation and swelling.
As mentioned earlier, the most common area is usually the big toe, but you can also get gout attacks in your foot, ankle, knees, elbows and other joints. Uric acid crystals will start to accumulate in these areas, causing painful pressure and swelling.
The attacks can last a few days, or many weeks before the pain goes away. Another attack may not happen for months or years, or it may happen sooner than you think. The swollen sites of gout attack that happen regularly are called tophi. Each attack can cause more damage, leading to loss of mobility in the joint.
Gout can also cause painful kidney stones due to the uric acid build-up. Medication can be used to reduce the risk of stone formation.
Gout can severely affect your quality of life. Luckily, there is a great deal more you can do these days even compared with just a few years ago to minimize the impact of gout. At your first bout of gout, it will be time to see the doctor.
When to See the Doctor
The pain of gout will send you running (or should we say hobbling) to the doctor in sheer agony, with an inflamed big toe or other joint.
Your doctor will ask questions about your symptoms and do a physical examination. They may also take a sample of fluid from your affected joint, such as your big toe, to look for uric acid crystals. This is the best way to test for gout and get a correct diagnosis.
Your doctor may also do a blood test to measure the amount of uric acid in your blood to see how high above normal it is. Once he (or she) has a full picture of your condition, he can make various recommendations for treatment of this attack, and the prevention of any future attacks or complications.
To stop a gout attack, your doctor can give you a shot of corticosteroids right into the painful joint. He might also prescribe a large daily dose of one or more medicines, including pain relievers. The doses will get smaller as your symptoms go away. Relief from a gout attack often begins within 24 hours if you start treatment right away.
Once your pain is finally gone, you will still need to follow up with your doctor. The uric acid that built up and lead to your gout attack can still harm your joints if you don’t monitor your levels regularly.
These are the short-term treatments for an acute (that is, sudden) attack of gout. There are various ways to treat chronic, (that is, long-term) gout in order to try to keep you pain free and avoid the damage and potential complications of chronic gout. Let’s look at this in the next section.
Treatments for Gout
The most important aspects of treating gout are short-term pain relief and long-term management to try to prevent damage to your joints that can lead to significant pain and disability. Long-term management can also help prevent complications related to gout that can lead to further illness.
Effective Pain Relief
The first consideration will be to relieve the pain. Rest the joint and elevate it if you can to reduce swelling.
NSAIDS
Over-the-counter drugs like ibuprofen (Advil, Motrin) or another non-steroidal anti-inflammatory drug (NSAID) like naproxen (Aleve) can also help you feel better. Don’t take aspirin. It can make gout worse by raising the uric acid levels in the blood.
If over-the-counter NSAIDS don’t work, your doctor might suggest prescription NSAIDs such as indomethacin (Indocin) or the COX-2 inhibitor celecoxib (Celebrex). They can offer effective pain relief without being too hard on the stomach compared to other options for gout.
Colchicine
Your doctor may also recommend colchicine (Colcrys, Mitigare) – a type of pain reliever that effectively reduces gout pain. The main issue with this drug, however, is that it is poorly tolerated by many people. Side effects include nausea, vomiting and diarrhea. After an acute gout attack subsides, your doctor may prescribe a low daily dose of colchicine to prevent future attacks, if you can stand it.
Steroids
Corticosteroid medications, such as the steroid prednisone, may control gout inflammation and pain. Corticosteroids may be administered in pill form, or injected right into any affected joint.
Steroids carry risks of side effects, so they don’t tend to be prescribed long term for gout unless you can’t tolerate NSAIDs or colchicine. Side effects of steroids may include mood changes, increased blood sugar levels and elevated blood pressure. If you are diabetic and/or have high blood pressure, you will need to steer clear of steroids for your gout.
Medications to Prevent Gout Complications
Once your acute gout is dealt with, your condition will be monitored over time. Keeping a gout diary of your attacks can help, including when, how severe, and what you might have done to trigger it.
If you experience several gout attacks each year, or if your gout attacks don’t happen too often but are very painful, your doctor may prescribe medication to reduce your risk of gout-related complications.
There are two main classes of drug:
1. Medications that block uric acid production
2. Medication that improves uric acid removal
Let’s look at each of these briefly.
1 – Medications that Block Uric Acid Production
Uric acid is produced by the body from the food you eat. Drugs called xanthine oxidase inhibitors limit the amount of uric acid your body produces. This may lower your blood’s uric acid level and reduce your risk of gout. Drugs in this class include:
- Allopurinol (Aloprim, Lopurin, Zyloprim) – Side effects of allopurinol include a rash and low red blood cell counts.
- Febuxostat (Uloric) – Its side effects include rash, nausea and issues with liver function.
2 – Medication that Improves Uric Acid Removal
Medications that improve uric acid removal cause it to be cleared more efficiently by the kidneys so they pass into the urine and are eliminated from the body. This can lower your risk of gout attacks because less uric acid means fewer crystals likely to form in your joints. However, the levels of uric acid in your urine will increase, which could lead to kidney issues.
- Probenecid (Probalan) is the only drug in this class thus far. Side effects include a rash, stomach pain and kidney stones.
As we can see, avoiding producing too much uric acid, and eliminating it efficiently from the body, can both help prevent gout.
Exercise
Exercise can also help with your gout when you are not in pain. It will help you manage your weight and preserve your range of motion. Sitting still will only lead to more pain and stiffness, as well as lack of mobility.
The main recommendation for dealing with gout is also to try a gout diet. Let’s look at this topic in the next section.
A Recommended Diet for Gout
The word diet has two meanings – a plan to lose weight, and one’s food choices. Both are important when it comes to arthritic conditions such as gout. In fact, this natural method may actually be the best one for dealing with your gout.
Paying attention to what you eat may help you manage your gout symptoms. Eat moderate amounts of a healthy mix of foods in order to control your weight and get the nutrients you need.
Drink plenty of water and avoid sugary or diet drinks. The water will help flush the uric acid from the body when you urinate and also make it less likely you will form painful kidney stones.
Weight Issues
The more weight we carry, the more pressure we put on our joints. Even losing one pound can take off four pounds of pressure on our toes, feet and ankles as we walk, especially if we are going down the stairs. Less pressure means less wear and tear on the joints.
Reducing Uric Acid
The main tactic of a gout diet is to avoid foods with purines in them, which can trigger attacks and severe pain. Foods with purines include:
- Organ meats, such as liver, kidneys, sweetbreads, and brains
- Meats, including bacon, beef, pork, and lamb
- Game meats such as venison and bison
- Anchovies, sardines, herring, mackerel, and scallops
- Beer
Foods that are protective include low-fat dairy like skimmed milk and yogurt.
Reducing Inflammation
For all forms of arthritis, including gout, an anti-inflammatory diet is suggested. Foods to avoid include:
- Red meat
- Gluten, a protein found in wheat
- White sugar and sugary foods like honey and agave
- Too much full-fat dairy
- Aspartame (NutraSweet, Equal) and other artificial sweeteners
- Too much salt (sodium)
- Monosodium glutamate, a flavor enhancer and meat tenderizer commonly used in Chinese food
Foods to add to your diet include:
- Omega-3 fatty acids, such as from fish like salmon
- Blueberries
- Cherries
- Leafy greens like spinach and kale
- Green tea
- Garlic
- Olive oil
These foods are also rich in antioxidants, which have powerful disease fighting and anti-aging properties. Research has shown that that main cause of aging is a process known as oxidative stress. Antioxidants fight oxidative stress.
Some people have also suggested that Vitamin C and cherries can help improve arthritis symptoms and lower levels of uric acid in the body naturally. Some studies have also shown that coffee can help. Use decaf to avoid the jitters.
Most of the foods in an anti-gout and anti-arthritis diet are low in calories, so they can help with your efforts at weight loss and weight control. They are also tasty and satisfying, and ideal for a balanced diet.
We’ve often heard the phrase. “We are what we eat.” Watch your diet and see what a difference it can make to your gout.
Final Thoughts
Gout is a painful condition that can lead to severe pain and disability if not managed well. In the short term, for your first acute attack, your doctor will make various recommendations for relieving the pain and ending the flare-up. Once it is under control, it will be a case of trying to prevent attacks, which can damage joints permanently.
Diet and exercise can help in relation to long-term or chronic gout. If your lifestyle measures still aren’t enough, your doctor will prescribe one more medications and monitor your condition.
Monitor all your symptoms related to your gout. Some people like to keep a gout diary to track their attacks and anything that led up to them. You can also track your symptoms to spot any side effects from the medications you are taking, in order to try to live your best life possible despite your gout.
Do all you can to prevent gout attacks, so it will have a minimum impact on your life, and you can retain your mobility well into your senior years.
